Fertility Insights

  1. 5 Facts Young Women Should Know About Endometriosis

    By Elizabeth Hoffman

    Elizabeth joins Fertility Insights as our correspondent on young women’s fertility. Elizabeth recently graduated from Dartmouth College, where she studied women’s health and also volunteered as a sexual health advocate. Her contributions to Fertility Insights will reflect the perspective of young women who may not want to become pregnant now, but wish to preserve future fertility options.

    March was Endometriosis Awareness Month, and given the worldwide success of EndoMarch, the efforts to educate on this disease have been impressive.

    As someone craves information on female reproductive health, I was happily surprised by how informative the awareness campaigns were. Given that many of my peers have never heard of the disease, and that it is a leading cause of infertility, I would like to share the information on endometriosis I find most pressing in hopes that education will contribute to better diagnosis and care.

    • Endometriosis is correlated with female infertility. Of the millions of women around the world who are unsuccessful in becoming pregnant after one year of unprotected sex, 25-50% have endometriosis. Conversely, 30-50% of endometriosis patients experience infertility. These data indicate a strong correlation between endometriosis and infertility.
    • Endometriosis is also a common disease. According the American College of Obstetricians and Gynecologists, endometriosis affects about 10% of reproductive age women.
    • It can cause extraordinary pain. Endometriosis is defined as the migration of endometrial cells—the tissue that females shed during menstruation—migrating from the uterus into the pelvic cavity. This migration can result in cysts and adhesions on the ovaries, fallopian tubes, outside of the uterus, and other tissues including the large intestine. Unlike normal endometrial tissue, it is trapped in the pelvic cavity without a way to exit the body, and it continues to respond to menstrual hormones, causing severe pain for many patients. The pain of this disease can be so severe that some women elect to have hysterectomies.
    • Endometriosis diagnosis is often very delayed.  According to EndoMarch organizers Million Women March, it takes between 6 and 10 years for most patients to receive an accurate diagnosis after the symptoms present. In 2006, Fertility and Sterility, a leading publication on reproduction, published a study on why there is such a significant delay in diagnosis. The researchers found a median delay of 102 months before diagnosis, with common factors for delay including doctors dismissing patient pain, hormonal suppression of symptoms (i.e. oral contraceptives) and imprecise diagnostic tools.
    • The only effective diagnostic tool is laparoscopy. Laparoscopy is a minimally invasive surgery that enables a physician to examine your internal organs. Currently there is no reliable imaging, blood or urine test that can diagnose endometriosis. Recently though, a leading researcher in the field from the Yale School of Medicine, Dr. Hugh Taylor, identified a genetic mutation that was associated with up to a third of endometriosis patients. Hopefully better, noninvasive diagnostic tools will result from ongoing research.

    If you experience intense cramping during your periods, pain during intercourse, urination or bowel movements, you should speak with your gynecologist about these symptoms and ask about endometriosis. As Ronny wrote in Fertility Insights last, your pain is not imaginary and deserves respectful consideration by your care provider.

  2. IVFkid1: Stories of Support and Hope

    Michelle Dipp, M.D., Ph.D.  By Michelle Dipp, M.D., Ph.D.

    Recently I had the pleasure of welcoming Elizabeth Comeau, the United States’ first IVF baby, to OvaScience to speak with our team about the importance of advances in fertility technologies to help patient communities. Ms. Comeau was born in 1981 in Norfolk, Virginia, where her parents had sought in vitro fertilization with Drs. Howard and Georgeanna Jones. The Carrs were actually from Massachusetts but had gone to Virginia because the use of IVF technologies was illegal in their home state.

    After three ectopic pregnancies and the removal of both fallopian tubes, Ms. Carr was unable to conceive naturally, and so cutting edge IVF technology was the only option for having her own biological child. Elizabeth addressed this, saying “I am grateful to be the product of hard work, determination, and really incredible science.” And while the circumstances of her conception are extraordinary—her parents were brave to be among the first to try IVF— Elizabeth and other fertility advocates emphasize that IVF babies are normal. One sperm fertilized one egg, resulting in an embryo that implanted in a uterus and created a child.

    I applaud the Carrs’ willingness to share their story. The family made the choice early on that, if they could help give couples like them hope or find the path to have their own child, it would be worth sacrificing their privacy for the rest of their lives. As the number of children born via IVF grows to over 5 million worldwide, I hope that the fertility community will embrace these stories to foster support and hope.

  3. Fertility Insights Celebrates EndoMarch

    By Ronny Mosston, MBA

    Today is an incredible day. Thousands of reproductive health advocates around the world will gather in a global movement to raise awareness for endometriosis. EndoMarch, organized by Million Women March for Endometriosis in more than 45 countries, unites thousands in an effort to empower patient communities, educate the public, and effect change within the medical community to move closer to ending the disease.

    Endometriosis is a relatively common condition in which the endometrial tissue that lines the uterus of a menstruating woman migrates out of the uterus. This can create cysts and adhesions on the fallopian tubes, ovaries and uterus. According the American Society for Reproductive Medicine, the symptoms of endometriosis include severe menstrual cramps, painful intercourse and even infertility. Estimates from Endometriosis.org indicate 176 million women worldwide suffer the painful disease.

    Like millions of others, I am all too familiar with these symptoms. From the age of 16, I experienced excruciating pelvic pain. At the time, no one could offer an explanation. Physicians told me this pain was “all in my head” and that there was nothing wrong with me. I submitted to over a dozen surgeries—invasive exploratory, diagnostic and therapeutic procedures that attempted to give answers or assuage my pain, often adding to the problem. I participated in debilitating clinical trials and scoured the country for specialists. Endometriosis was not something I endured; it was a force that controlled almost every day of the month. Days 1-5 post period were my only ‘sane days.’

    Today, I am ecstatic to see the progress that has been made in the research, diagnosis, treatment and support of patients with endometriosis. My hope is that no woman is told “it is all in your head” ever again. Twenty years ago reproductive experts thought my symptoms were a delusion; today the top authorities in women’s health not only acknowledge the condition but sponsor advocacy efforts like EndoMarch.

    While many women suffer through endometriosis without knowledge of their disease or treatment to help them, and we still lack effective treatments, the community of patient advocates so active today is truly heartwarming. I applaud the headway we have made so far and look forward to the next generation of young women being free from this disease.

    Ronny Mosston

  4. What New SART Data Tells Us about Age and Fertility

    Michelle Dipp, M.D., Ph.D.  By Michelle Dipp, M.D., Ph.D.

    On Monday the Society for Assisted Reproductive Technology (SART) released the 2012 clinical data from its 379 member clinics. Some of this information made 2012 a record-breaking year for fertility treatments, while other outcomes reflected the same clinical trends the community has seen for decades.

    Among the historical news is that in 2012 we saw the largest IVF utilization of all time. A total of 165,172 cycles were performed, bringing 61,740 babies to parents and families. Additionally, the number of multiple births declined substantially, meaning fewer women went through high risk and costly deliveries. I am excited to celebrate these outcomes.

    While more children were born through ART and under safer circumstances, the infamous challenge of age-related infertility remains a pressing issue for thousands of patients. While advancements like hormone stimulation, intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis (PGD) have helped women of advanced maternal age have their own biological children, many are still left with few effective treatment options. As the SART data shows, older mothers and their care teams still struggle to become pregnant and deliver a child.

    Age and ART Outcomes (2012)

    So what does the new SART data tell us about age and fertility?

    Thus far, our technologies do not enable us to overcome the reproductive impacts of aging. As women continue to delay childbearing, I believe age-related infertility will become an increasingly burdensome condition. I know that many of us are dedicated to developing more options for these patients.

    Percent of ART Cycles Resulting in Live Births

  5. 8 Healthy Habits to Maximize Your Fertility

    By Elizabeth Hoffman

    Elizabeth joins Fertility Insights as our correspondent on young women’s fertility. Elizabeth recently graduated from Dartmouth College, where she studied women’s health and also volunteered as a sexual health advocate. Her contributions to Fertility Insights will reflect the perspective of young women who may not want to become pregnant now, but wish to preserve future fertility options. Below Elizabeth offers an overview of choices young women can make to maximize their fertility.

    A mantra my mother often tells me, one she learned from her mother, is that an ounce of prevention is worth a pound of treatment. I think this attitude is one that also applies well to fertility. We are all born with certain bodies, some more fertile than others, but there are healthy habits we can all adopt to maximize potential future options.

    Below I suggest eight healthy habits to maximize your fertility, however this is not an exhaustive list and I am not a doctor. As always, consult a physician before making any changes to your diet or exercise regime.

    • Maintain a healthy body weight. A healthy weight is part of a healthy body, and being either too lean or too heavy can impact your reproductive wellbeing. A female body with too little fat will stop producing leptin, a hormone that triggers the menstrual cycle, resulting in amenorrhea. During amenorrhea the ovaries do not release eggs, a process called ovulation, and menstruation stops. Females who do not ovulate cannot become pregnant, but even those with a history of an eating disorder have been found to experience higher rates of infertility. Similarly, obesity can interfere with a healthy endocrine system and puts overweight females at increased risk of ovulatory disorders.
    • Learn to love vegetables. Our bodies require careful nutrition to function at their best. When thinking about fertility in particular, vitamins and minerals to incorporate into your diet include iron, vitamins A, D and folic acid. Iron and vitamin D promote healthy ovulation, and vitamin A and folic acid promote healthy fetal development. Making these foods part of your diet now will help set good habits for when you are looking to conceive, and help your bone, heart and eye health in the meantime. Good sources of iron and folic acid are leafy greens and fortified cereals, and for vitamin A, carrots are a go-to. Many dairy products have vitamin D fortifications, with the added bonus of calcium, which is especially important to females, who are at greater risk of osteoporosis than males.
    • Understand your baseline. Information helps me feel empowered to make good choices about my body and health, and the best information comes from visits with my care provider. The American Congress of Obstetricians and Gynecologists recommends that young females first consult with their gynecologist between the ages of 13 and 15 to discuss healthy habits, personal hygiene and potential immunizations. At 21, females should have their first pelvic exam to assess internal and external reproductive health. If you are experiencing pelvic pain, menstrual disorders, or vaginal discharge, you should speak with a doctor about having an internal gynecological exam, regardless of age. Appointments with your care provider will establish a relationship and, ideally, help you feel empowered about your reproductive health.
    • Become your own health advocate. Once you understand the ins and outs of your body, so to speak, take charge of your health and prioritize it in your lifestyle. For those of us with chronic conditions, this means extra work, every day. Do your best to follow your physician’s treatment plan and find allies who support you doing so. Diseases such as polycystic ovarian syndrome (PCOS), endometriosis, diabetes, and celiac disease, among others, can wreak havoc on the reproductive system if not properly managed, so try to be mindful of the long-term consequences your choices now may have.
    • Practice safe sex. Protecting your body from sexually transmitted infections (STIs) is one of the most important ways of respecting your body and protecting your reproductive health. STIs such as chlamydia and gonorrhea can cause pelvic inflammatory disease (PID), potentially damaging the fallopian tubes, ovaries and uterus, and increasing the risk of infertility. According to the Centers for Disease Control and Prevention (CDC), most females with chlamydia and gonorrhea infection do not display any symptoms, so it is important to protect your body from STIs up front using barrier method contraception, including male and female condoms. Regular STI screenings may also help identify undetected infections.
    • Avoid toxic substances. Most people in my generation are aware that cigarettes are harmful to your health, increasing smokers’ risk of lung cancer and heart disease. Only 22% of the general population knows that smoking can also affect fertility. According to the American Society for Reproductive Medicine, smoking cigarettes increases females’ risk for delayed conception, ovarian follicular depletion and even chromosomal damage in eggs. Additionally, research suggests that exposure to lead, pesticides, and BPA can impair female fertility.
    • Know your options. In 2013, the American Society for Reproductive Medicine and American Congress of Obstetricians and Gynecologists removed egg freezing from the national list of experimental procedures. While more research is needed on the potential benefits of egg freezing, young females who anticipate delaying childbearing into their mid or late 30s should consider financial preparations for egg freezing, which can cost up to $15,000, if not the procedure itself.
    • Give yourself permission to take a break. Stress can affect our bodies, often targeting our hormones and potentially interfering with normal menstrual signaling. In our fast-paced, technology-oriented society, it can be difficult to carve out time to take care of ourselves instead of our work. However, practicing self-care can have immediate and long term health benefits, both mental and physical. Good self-care methods include moderate exercise, meditation, attending religious or spiritual services, spending time with loved ones, practicing your preferred art form, and ensuring sufficient sleep (7-8 hours per night). Cultivating respect for your mind and body will also help motivate you to maintain the other healthy habits suggested here.

    Just as good health is an ongoing goal to pursue, each person’s ability to prioritize it is dynamic. Remember that your personal best is all you can offer, and some parts of our fertility are simply beyond our control.

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